Future of Health Care – articles, videos and Futurist keynote presentations on the future of health care, biotechnology, MedTech, stem cells and related health trends by Dr Patrick Dixon, author of The Genetic Revolution, Futurewise and the Future of Almost Everything, whose clients include over 400 of th3e world's largest companies, including many pharma companies, hospitals, clinical research teams and Government Health Departments.

The future of health care is highly complex and rapidly changing - dependent not only on innovation but also on demographics, culture, lifestyle expectations, political will and commercial realities.

Health care is increasingly globalized, even though at first sight it always seems to be delivered locally.

There is a global and highly mobile market for nurses and doctors. Developed nations, who are short of qualified, low cost nursing staff, are recruiting many tens of thousands of nurses every year from emerging nations, whose governments have paid large amounts towards training. This is resulting in chronic staff shortages in poorer nations.

Global treatment centres: We are also seeing rapid growth in medicaltourism – where people in developed countries are travelling to be treated by highly qualified hospital teams in low cost nations, pocketing the difference in private health care costs, even after adding on a holiday for convalescence.

Global technology, pharma and biotech: Health care innovation is expensive and requires huge economies of scale – whether in designing a new brain scanner or developing a new therapy. For this reason we will go on seeing rapid consolidation in medicaltechnology and pharmaceutical companies, including biotechnology. It can cost over $1billion to bring a single new drug from early research into clinical use.

Global pricing and marketing: In a digital online world it is no longer sustainable for pharma companies to try to enforce two or three different price bands for the same medicine, depending on the country / region.

Global generics: It is increasingly difficult for pharma companies to protect their intellectual property against the onslaught of low-cost generic manufacturers, who are seen by many governments as useful agents in keeping down health care costs.

Global lawsuits: At the same time, in many nations the number of medical lawsuits is growing fast, threatening hospitals and individual doctors with enormous annual insurance bills. Expect a growing number of global class actions against drug manufacturers, whose therapies are under attack.

Global regulation: Expect a more joined-up approach to approval of new drugs. Risk averse regulators are increasingly anxious about blame if they let new drugs onto the market without the most rigorous testing

– which can add hundreds of millions onto the costs of bringing new drugs to market. Expect a global debate about the balance between cost reduction, speed to market of much-hoped-for therapies, and public safety.

Other major issues in health care: include the ageing population in many parts of the world, increasing health demands and expectations, growing costs of new medical technology, techniques, procedures, treatments – and inability of governments to fund in an age of austerity, cutbacks and repayment of government debt.

A major disappointment is the lack of innovation in the pharmaceutical industry, with slow progress for example in development of new antibiotics or radical approaches to major health problems such as multiple resistant infections, diabetes, alzheimers, stroke, heart attack and cancer. 70% of pharma research spending is by a few big companies, yet 70% of discoveries are by some of over 4,000 biotech startups.

We have also seen slower than expected results from the human genome project – few gene therapies.

Rapidly falling costs of well-established and proven drug therapies. Reason is the (short) 25 year patent life on new molecules, of which up to 15 may have been used in development. This means that in many cases, superb but very expensive drugs that are barely a decade in clinical use, are suddenly available at a fraction of the previous price, sourced from generic manufacturers. Bad news for pharma companies. Good news for those in low income nations.

Medical diagnostics are also improving rapidly and existing technology is falling in price. Because many of them are based on powerful computer image processing, the cost per diagnosis is falling, just as computer power is increasing.Huge advances in micro-surgery using thin wires and tubes threaded into arteries, veins or inserted into body cavities. Endoscopy has already revolutionized operations on gall bladders, ovaries, intestinal polyps and a host of other conditions that used to require major surgery.

Increasing survival rates for all major health conditions in almost all nations.

BIG TRENDS TO WATCH:

1. Total integration of health data about an individual across all departments, hospitals, clinics, and community teams, including instant access to all scans, images, laboratory results, backed by computer-assisted diagnosis and treatment planning. At the same time, expect well-publicised cases of hacking and data loss, with public angst over privacy.

2. Community diagnostics – self-testing at home for a wider range of conditions, plus mobile monitoring using devices which communicate with smart phones and other technologies, to anticipate and help manage events such as heart attacks. Self-testing will be particularly attractive to those who prefer their own medical information to stay within their own brains rather than risk dissemination across the entire internet through some digital accident.

3. Multi-disciplinary community care teams, based in health centres, able to diagnose and manage many medical emergencies at home, preventing hospital admissions.

4. Gene prophecy – profiling of individuals to match with others whose medical histories are known. Expect costs to fall to less than $100 for a sophisticated screening, and a range of new ethical dilemmas – what do you do with the information? Are insurers allowed to discriminate in policy making on the basis of results? Do you want to know if you are going to develop a much-feared serious and progressive condition at some time in the future? Expect an increase in pharmacogenomics where treatment outcomes are matched with genetic code of the individual or of their tumour cells. This will mean much better targeting of therapy, reduction of side effects, better response rates, but lower sales of each drug (so higher prices per dose).

5. Virtual medicine- has been a slow starter. We have seen many wild predictions about robotic surgery being routine with patients and surgeons several thousand miles apart – they were silly at the time and look even more foolish today. The fact is that remote medicine works superbly when specialists are interpreting data or images, but is not comforting to an anxious patient or their family when it comes to surgery. Remote surgery is handicapped by the simple fact that light travels too slowly around the world – which means significant delays in long-distance transmission from one end to the other, even without accounting for time needed in compression of signals, and other processing delays.

6. Adult stem cellsto regenerate damaged tissue - brain, spinal cord, retina, heart and other tissues. Scientists are making rapid advances in this area, using a patient's own cells, following some success in animal studies.

Innovation in clinical management means that the place of treatment is changing – or ought to change – for many people, yet the old teams and systems often remain highly resistant to change.

Health services are often dominated by battles between specialists within the same hospitals for resources, or between hospitals and community services. It can be very difficult to restructure when groups are strongly defending their own interests.

An example is the shift from hospital to community care: if hospitals continue to run wards with empty beds, then emptying more beds by keeping patients in the community, may not save the hospital much money at all.

The answer is visionary leadership at regional level, able to see the big picture, and to organize appropriate services.

Many governments are recognizing that leadership alone is not enough without the discipline of market forces, which are driven by the result of thousands of decisions by local doctors and their patients. In this way, the blame is taken away from a government minister if – say – a poorly performing hospital has to close half its beds because no one wants to be referred there.

The big question is this: how can the health service deliver more at lower cost? One answer is to restrict the prescribing of newer therapies (where the patent still exists and prices are high). Another is to accelerate the transfer from traditional hospital care to out patient care with community support. A further strategy is to shorten hospital admissions with rapid mobilization of community teams to take people home, and to prevent new admissions by early diagnosis and treatment in the community.